经胃入路NOTES手术的解剖研究  

Anatomic research of gastric pathway in NOTES

作　　者：戚大川 俞华 施新岗[2] 方军[2] 谢静[2] 王东[2] QI Da-chuan;YU Hua;SHI Xin-gang;FANG Jun;XIE Jing;WANG Dong(Surgical Department of Shanghai No.6th Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200081,China;Gastroenterology Department of Changhai Hospital Affiliated to The Second Military Medical University,Shanghai 200433,China)

机构地区：[1]上海市第四人民医院普外二科,上海200081 [2]上海第二军医大学附属长海医院消化科,上海200433

出　　处：《中国现代普通外科进展》2020年第10期782-785,共4页Chinese Journal of Current Advances in General Surgery

基　　金：上海市卫计委自然基金(20124364)。

摘　　要：目的:通过对人尸体的解剖观察,探讨选择经胃NOTES穿刺点的必备要素,为NOTES的手术入路提供可以借鉴的解剖依据。方法:福尔马林固定的标本34具,预先经肝门静脉灌注蓝色乳胶,经股动脉灌注红色乳胶,用于测量胃网膜血管分支间的距离、分支的长度,胃网膜血管的分布特点的形态观察和进行血管测量。结果:胃网膜动脉主干发出的长分支血管长度为(1.4±0.2)cm,胃网膜动脉主干发出的短分支血管长度为(0.4±0.1)cm,胃网膜动脉长分支间的平均距离(1.3±0.5)cm,最佳穿刺点至大弯距离为(2.9±0.6)cm,最佳穿刺点至幽门距离为(7.9±0.9)cm,最佳穿刺点至胃角距离为(3.1±1.0)cm;内镜下尸体标本中,胃大弯皱襞间数量(6.2±1.2)个;内镜下尸体标本中,最佳穿刺点与胃大弯皱襞间的解剖关系:(1.9±1.2)cm;内镜下尸体标本中,最佳穿刺点与窦体交接线间的解剖关系:(2.4±1.5)cm。结论:胃网膜动脉主干发出的分支血管呈现长短长短的规律。最佳穿刺点在未被肝脏覆盖的胃前壁游离区,避开胃网膜血管分支。最佳穿刺点距胃大弯皱襞间的距离为(1.9±1.2)cm,与窦体交接线间的距离为(2.4±1.5)cm。Objective:In this research,we observed 34 corpses,measured distances between branches of gastroepiploic arteries,length of those branches;described the distribution of gastroepiploic vessels.We hope our research can provide some evidences of the best approach in NOTES.Methods:There were 20 male and 14 female corpses we measured.At first,we infused blue latex solution into portal vein and red latex solution into arteria cruralis.We measured distances between branches of gastroepiploic arteries,length of those branches;described the distribution of gastroepiploic vessels.Results:The mean length of long branches from gastroepiploic arteries is(1.4±0.2)cm,and that of short branches is(0.4±0.1)cm.The mean distance between each branches is(1.3±0.5)cm.The best punctured area is(2.9±0.6)cm from greater curvature,(7.9±0.9)cm from pylorus,and(3.1±1.0)cm from gastric angle.There are(6.2±1.2)folds on greater curvature,mean distance between the punctured area and the middle of those folds is(1.9±1.2)cm.And this area is(2.4±1.5)cm away from the separate line between the stomach body and pylorus.Conclusion:Short and long branches of the gastroepiploic arteries are distribute alternately in stomach.The sweet area of puncture is located on the gastric anterior wall that is not covered by the liver.

关 键 词：经自然腔道手术 解剖学 手术入路 

分 类 号：R332[医药卫生—人体生理学]